The Power of Teamwork
In today's increasingly complex healthcare environment, teams offer medical practices a way to produce more -- without compromising quality.
By Carolyn Pickles, MBA, FACMPE, Springfield, Mass.

If you're like most doctors today, you're looking for ways to make your practice run more efficiently and increase patient satisfaction. Having a group of your staff members work together as a team to reach a goal -- such as streamlining a procedure, improving care or responding to increased competition -- can be a powerful way to accomplish this. It's a different and surprisingly effective way to take advantage of your most powerful resource: the people who work for you.

In this article, I'll describe different types of teams you might want to use in your practice, explain how they can help your practice be more effective, and offer some advice on creating and managing teams in your office.

Teams: a host of benefits

Why should you consider using teams in your practice? Empowering teams to handle different tasks has multiple benefits:

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• Teams allow a practice to take advantage of the ideas and experiences of individuals at all levels.
• Increased innovation results when multiple contributors work together, each with different viewpoints, talents and experience. A team can produce results that far exceed what an individual can accomplish.
• A practice often becomes much more flexible and adaptable when teams are implemented because policies aren't based on a single individual's preferences or bias.
• The direct feedback inherent in the team approach helps staff members learn from each other, and the clarity that comes from group discussion and feedback leads to better results.
• The sharing of responsibility increases turnaround and leads to more effective action.
• Team meetings allow your staff to express their feelings and opinions, and engender a sense that they have some control over their jobs. The increased sense of control results in more commitment and motivation to make changes work.
• By empowering your employees to resolve problems, make improvements and develop new programs and processes, you provide an opportunity for personal growth and enrich their professional lives.
• Using teams in your practice minimizes conflicts between you and your staff.
• These multiple benefits for your staff result in less turnover and absenteeism.

In contrast, the traditional, hierarchical management approach often leaves employees feeling disenfranchised, with little authority to streamline cumbersome processes or correct problems. Employees may have to wait for the practice administrator or a doctor to evaluate solutions or improvements before any action can be taken.

For all of these reasons, making the switch to using teams can often work wonders for a practice.

Using the right type of team

Different kinds of teams with varying purposes, levels of responsibility and durations of existence can help you address many different issues in your practice. Here are four effective types of teams often used in industry:

Quality team. The mission of this type of team is to generate and implement ways to improve areas such as service, functionality, and operations for the benefit of employees and patients. A quality team, for example, might find ways to reduce patient wait time or improve billing turnaround. (Once created, this team is usually more or less permanent.)

Members should be front-line employees who are in close contact with patients. In order to be effective, they need to have the authority to implement improvements.

A practice using this type of team should have quality service as a primary goal, so that plans for improvement won't be constantly overruled by other priorities.

Project/task team. This type of team is created to complete a specific task, such as developing a new patient education program or analyzing whether your practice should offer a new service. It usually disbands once the assigned task is complete. The best staff members to choose for this type of team are visionary individuals who are capable of interpreting data and planning for the future.

For a project team to be successful:

• Members should have a clear understanding of the assigned project and the opportunity it presents.
• You must provide the team with access to all necessary information and resources.
• Team members should be protected from criticism by nonmember employees.

Cross-functional team. To bring different areas of functional expertise to the team and ensure that all practice needs are met, members of a cross-functional team are drawn from different departments. This type of team might be used to analyze and improve overall patient satisfaction or decrease interdepartmental problems. Cross-functional teams can be either permanent or temporary.

Self-directed team. This type of team is empowered to take over responsibilities and actions that would previously have been handled by management staff. Team responsibilities might include making changes in work responsibilities, hiring and terminating employees, and allocating bonuses or pay increases. Team members usually have training in management and administrative support. Leadership is shared among members, and decisions are made by consensus.

This type of team is usually permanent and often operates with minimal supervision. It might address challenges such as maintaining profitability in the face of increased competition or managing downsizing.

When a self-directed team is implemented, the role of management is radically changed. Supervisors typically move into new roles, such as team coaches, technical advisors, trainers, multi-team managers or team members. Managers may become responsible for developing people, communicating the organization's direction, providing feedback to teams, fixing team problems, or maintaining external relations.

Using this type of team in a medical office can result in a complete restructuring of the practice. In fact, this type of team is less often found in medical settings, probably because boundary issues between physicians, nurses, and administration present difficult challenges. Because of these potential difficulties and the extensive changes involved, I wouldn't recommend using this type of team in your practice.

To team or not to team?

When deciding whether to try this in your practice, it's important to remember that not all situations are appropriate for teams. Before implementing a team, your practice administrator needs to determine:

• What problem or situation does your practice need to address? (If this isn't clearly established, the team's purpose may be misstated, leading to less than helpful results.)
• What do you want the team to accomplish?
• Is a team the most effective way to manage the situation?
• Which type of team would work the best?

Getting started

If you decide that a team is the right way to proceed, it's important to begin by developing a "problem statement" for the team. (Note that this should not be a statement of the anticipated solution.) This will start the process with a clear direction in mind. Once the team is formed, members can create more specific documents such as a mission statement.

Next, select the team leaders and team members.

Selecting team leaders

Typically, team leadership is handled by two individuals: a team sponsor, and a team leader.

The team sponsor. The sponsor isn't a team member. He (or she) champions the team within the practice and is involved with team set-up issues, such as determining the type of team and its purpose, membership, leadership, and objectives. The sponsor also establishes the correct organizational atmosphere so the team can succeed. Once the team moves forward in its development, the team sponsor's role diminishes.

The team leader. This individual functions as a guiding force within the team. He or she typically "jump starts" the team, functioning initially as the team chairperson. The leader's responsibilities include:

• briefing members
• setting meeting agendas
• establishing team processes
• managing the development of internal team behavior
• serving as the communication liaison between the team and the team sponsor
• allocating work among team members
• making sure that the team reaches its goal on time.

The team leader may be appointed or elected by team members. Sometimes responsibility for team leadership is rotated or shared among team members.

Depending on the size of your practice, the team sponsor and team leader could be the same individual. In some cases, it might make sense for the practice administrator to serve in both roles.

Selecting team members

Clearly, having the right people on the team is essential. Team members should be selected based on:

• current position (or function)
• previous experience, including team experience
• amount of training
• a proven talent for creativity and innovation
• personality (including the ability to get along with others).

Note: An effective team should be made up of a variety of personality types. Without that variety, team members won't complement one another, and the team may "strangle" itself on its own best qualities.

Creating a mission statement

Every team needs to develop a mission statement to understand its purpose, help create cohesiveness and ensure the group will reach its goals. Also, the development of team rules and objectives as part of that statement is essential so that the team can conduct periodic self-analysis. The mission statement should be developed based on open discussion among team members about the team's purpose and vision. It should include both values and objectives:

Team values. It's important that the team develop a consensus regarding how members will conduct themselves. Team values should include:

• being open to differences of opinion
• telling the truth
• dealing with mutual irritation, rather than ignoring it
• being reliable
• being considerate
• being bound by team decisions.

The team value system will help the team address the problems that invariably arise when working together.

Team objectives. Teams create objectives naturally after their initial briefing on team purpose given by the team sponsor (possibly in conjunction with the team leader). Objectives should provide a specific set of benchmarks that team results can be measured against.

Other secrets to team success

Once your team is up and running, you can help ensure its success by taking some basic steps:

Provide training. Members of a team should receive training in three areas:

• business skills such as budgeting, planning and project management
• skills relating to team development. This can be handled by purchasing a set of "how to" teambuilding books at a local bookstore and letting team members study them, or by bringing in a trained facilitator to coordinate team development.
• interpersonal skills training. This will help members learn effective methods for handling the differences that inevitably arise when working as a team.

Provide practice support. To ensure the success of a team, your practice should:

• embrace innovation and new ideas -- and convey to team members that the practice owners really are open to new ideas and recommendations
• give high priority to quality and superior service
• be willing to make organizational changes
• make sure the team members understand teambuilding process and issues
• provide clear, realistic expectations for the team in terms of goals, timelines, output, and how results will be measured
• allow the team time to develop, as members may not have worked together in this way before
• provide appropriate recognition for the team's efforts and successes. (Typically, only self-directed teams are directly compensated for team performance.)

Schedule regular team feedback sessions. To maintain and measure its success, your team should schedule regular feedback sessions to stop and look at what the team has accomplished -- and decide whether the team is still on track.

A change for the better

Changing the way things are done in your practice may take some getting used to, but teamwork could significantly help both your practice and your staff. And it doesn't require a large investment of time or money. Why not give it a try? 

Carolyn Pickles, MBA, FACMPE, is the administrator of New England Dermatology & Laser Center in Springfield, Mass., and vice president of Massachusetts Medical Group Management Association. As you might expect, she is the team leader of her employer's cross-functional team. Note: This article is based on a paper originally written in partial fulfillment of comprehensive requirements to become a Fellow of the American College of Medical Practice Executives.